Preoperative Opioid Use Negatively Affects Patient-reported Outcomes After Primary Total Hip Arthroplasty

Abstract

Background: Opioid use is a public health crisis in the United States and an area of increased focus in orthopaedic surgery. The aim of this study is to investigate whether preoperative opioid use had any effect on patient-reported outcome measures (PROMs) before and after total hip arthroplasty (THA). Methods: A total of 389 patients with THA with both preoperative and postoperative PROMs were reviewed: (1) 76 patients with preoperative opioid use (24%) and (2) 237 patients without preoperative opioid use (76%). Patient demographics and clinical information including opioid use, length of stay, and implant information.Results: Preoperative opioid users were more likely to stay in the hospital longer (P = 0.004) and be discharged to a rehabilitation facility (P = 0.038). Postoperatively, the Physical Function Short Form 10a (P = 0.021) and Patient-Reported Outcomes Measurement Information System Global-10 (P , 0.001 physical, P = 0.001, mental) were significantly lower in the preoperative opioid users. Within groups, both nonusers and preoperative opioid users saw improvements after THA in Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (P , 0.001), Short Form 10a (P , 0.001), and Patient-Reported Outcomes Measurement Information System Global-10 (P , 0.001, physical and P = 0.008, mental). Discussion: Although all patients reported improvements after THA regardless of preoperative opioid use, preoperative opioid users undergoing THA had significantly lower patient-reported outcome scores, longer hospital stays, and a more likely discharge to rehabilitation.B eginning with the initiation of the American Pain Society "Pain, The Fifth Vital Sign" campaign in the 1990s and the subsequent mandate by the Joint Commission on the Accreditation of Healthcare Organizations to provide pain assessment and treatment for all patients in ac-credited healthcare settings, an opioid epidemic has risen in the United States. 1 Opioid use is the leading cause of accidental death in the United States, and more than 2.4 million Americans have a severe opioid use disorder. 2 Consequently, increasing focus has been placed on

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

“…4,6,7,20,56,59 Similar studies have also identified preoperative opioid use as a negative predictor of patient-reported outcome measure scores, with lower preoperative baseline scores and lower overall change in function after arthroplasty. 12,31,32,33,50 A similar relationship has been found in patients undergoing RCR. 45,58 However, there is a paucity of data regarding the relationship between preoperative opioid use and postoperative complications, health care utilization, and need for revision surgery after RCR.…”

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

“…In addition, the use of preoperative opioids among orthopedic patients has been reported to cause poor clinical outcomes and increase the risk of reoperation. 30 31 We also found that among the current opioid users within three months after fracture, patients with a history of opioid use within six months prior to the fracture had a higher risk of sustained opioid use. This finding is in agreement with the results of a study that reported that preoperative opioid experience could increase the likelihood of opioid abuse.…”

Opioid use prior to surgery is associated with worse preoperative and postoperative patient reported quality of life and decreased surgical cost effectiveness for symptomatic adult spine deformity; A matched cohort analysis

“…The results from this study support the growing evidence that preoperative opioid use is associated with worse surgical outcomes compared to nonusers. [6,10,18,20,[32][33][34][35] Using a propensity score matched analysis of SASD patients enrolled into a prospective, multi-center study, we found that SASD patients using opioids preoperatively 1) reported worse preoperative quality of life including greater pain, worse physical function and mental health, and worse selfimage, despite having similar medical comorbidities, and similar magnitudes of spine deformities as preoperative nonusers; 2) demonstrated longer ICU stay and longer hospital stay, despite having similar surgery performed as preoperative opioid nonusers; 3) had worse quality of life following surgery including greater residual pain, worse function, worse self-image, and were less satisfied with surgical treatment, despite having similar surgeries and similar complication rates as preoperative opioid nonusers; 4) had greater hospital costs and worse postoperative cost/QALY; and 5) had greater postoperative opioid use and had 4.7 times greater risk of continued opioid use at mean 3.3 years postoperative follow-up compared to nonusers. Little data exists regarding the impact of preoperative opioid use on outcomes for SASD.…”